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Image-Guided Biopsy and Ablation Techniques

Image-Guided Biopsy Introduction There is an increasing role for imaging in the planning and performance of biopsy procedures. It is generally deemed unacceptable in modern practice to perform ‘blind’ biopsies on anything other than the most superficial lesions when imaging can provide real-time monitoring of biopsy needle position. Image-guided biopsies improve diagnostic accuracy and reduce complication rates. Ongoing technological advances are providing us with new and…

Peripheral Vascular Disease Intervention

Since the first edition of this textbook, vascular radiology has changed beyond recognition. It was only 30 years ago that the role of radiology in the vascular system was mainly to provide diagnostic images using invasive angiography. Since the development of interventional techniques in the late 1980s, interventional radiologists have assumed a major role not only in the diagnosis of vascular disorders but also in their…

Aortic Intervention

Introduction Open surgery for the treatment of aortic pathologies is technically demanding for surgeons and invasive for the patient. It is a major physiological insult often resulting in significant morbidity and mortality. Mortality rates from elective surgery of open thoracic and abdominal aneurysms are in the region of 8% and 5%, respectively. Additionally, the cohort of patients requiring aortic intervention commonly have a significant number of…

Angiography: Principles, Techniques and Complications

Introduction It was Dos Santos who performed the first diagnostic angiogram in 1929 in Lisbon. With the introduction of the Seldinger technique in 1953, the procedure became much safer and was rapidly popularised ( Fig. 78.1 ). Diagnostic angiography was developed for the diagnosis of many diseases; and hospitals in the 1960s and 1970s often had many angiosuites. With the introduction of the computed tomography (CT)…

Current Status of Imaging for Interventional Procedures

Introduction Noninvasive cross-sectional imaging with computed tomography angiography (CTA) and magnetic resonance angiography (MRA) plays a crucial role in the diagnosis and preintervention assessment of patients with vascular disease. Because imaging of vascular disease imposes stringent requirements in terms of high spatial and temporal resolution, many of the developments in computed tomography (CT) and MR have been spurred by the demands that cardiovascular imaging places in…

Paediatric Neuroradiology

Normal Brain Maturation Brain maturation is assessed by observing tissue characteristics related to myelination, as well as variations in morphology. Most of the changes associated with myelination occur in the first 2 years of life, and gyral and sulcal development mainly occurs in utero or in the premature brain, while other morphological changes are observable later in life. Normal Myelination Myelination is the process by which…

Bone Tumours and Neuroblastoma in Children

This chapter should be read in conjunction with the descriptions of bone tumours in adults (see Chapters 40 and 41 ). Bone Tumours The most common presenting symptom of bone neoplasms is skeletal pain. Plain radiography remains the first diagnostic step. Lesion location, appearance and patient age may help to suggest a diagnosis. Magnetic resonance imaging (MRI) defines soft-tissue and intramedullary extent, joint involvement and relationship…

Paediatric Musculoskeletal Trauma and the Radiology of Nonaccidental Injury and Paediatric Factures

Fractures account for up to 25% of all injuries in children, being commoner in boys. The type and distribution of injuries vary throughout childhood. There are significant differences in the type of fractures seen in adults because of the difference in the physiology and anatomy of the developing skeleton. Simplistically, a child's bones are more elastic than those of an adult and there is a greater…

Skeletal Radiology in Children: Non-Traumatic and Non-Malignant

Constitutional Disorders of Bone Nomenclature The naming of constitutional disorders of bone can be confusing. Constitutional bone disorders include osteochondrodysplasias and dysostoses. Osteochondrodysplasias consist of dysplasias (abnormalities of bone and/or cartilage growth) and osteodystrophies (abnormalities of bone and/or cartilage texture). Osteochondrodysplasias are due to intrinsic abnormalities in bone and cartilage, and because of gene expression will continue to evolve throughout the life span of the individual.…

Imaging of the Kidneys, Urinary Tract and Pelvis in Children

Overview In this chapter, we cover the important areas of renal, urinary tract and pelvic imaging in children, emphasising the importance of congenital abnormalities and the need for minimising radiation burden and optimising image quality. Ultrasound (US) is the preferred method for imaging the paediatric population, due to the ease of availability, lack of ionising radiation, reproducibility and because it is usually well tolerated. Modern US…

Paediatric Abdominal Imaging

Introduction Paediatric gastrointestinal (GI) radiology is most appropriately approached and dealt with according to the age of the patient, and for this reason the chapter has been subdivided into sections; the first details neonatal pathology and the latter relates to older children. In this latest edition, we present updated imaging techniques and management details. Summary Box: The Neonate Neonatal abdominal problems present according to the level of…

The Neonatal and Paediatric Chest

The Neonatal Chest Normal Anatomy and Artefacts The anteroposterior (AP) diameter of the neonatal chest is almost as great as its transverse diameter, giving the chest a cylindrical configuration. The degree of rotation is best assessed by comparing the length of the anterior ribs visible on both sides. As newborn chest radiographs are taken in the AP projection, the normal cardiothoracic ratio can be as large…

Current Status of Paediatric Imaging

Medical diagnostic imaging has evolved and rapidly improved over the past five decades as a result of novel developments in diagnostic digital imaging and interventional techniques. With technical advances in computer processing power, high-resolution display monitors/workstations, increased computing power and electronic data archive systems, diagnostic imaging departments have transformed from being labour-intensive analogue film-based imaging units into fully integrated digital environments. However, with all this new…

Functional and Molecular Imaging for Personalized Medicine in Oncology

Personalised Medicine in Oncology One of the major aims of oncological imaging is to detect and differentiate a tumour from normal tissue and thus it is necessary to understand the fundamental cellular changes that occur when a tumour forms, and how these can be used to generate tissue contrast. On the very simplest level, the differences in x-ray attenuation and water content between cancer and its…

Imaging for Radiotherapy Planning

Radiation therapy has been used as a treatment for cancer for more than 100 years, with its earliest roots dating back to the discovery of x-rays in 1895. Its development in the early 1900s is largely due to the work of Marie Curie (1867–1934), who discovered the radioactive elements polonium and radium in 1898. Despite these distant origins, radiotherapy remains at the forefront of the treatment…

Bone Marrow Disorders: Non-Neoplastic Conditions

This chapter deals with a variety of non-neoplastic blood-related disorders that have a major influence on imaging of the skeletal system. Disorders of Red Cells In late fetal life and infancy, the entire bone marrow is utilised for red blood cell (RBC) production, supplemented by extramedullary haematopoiesis (EHM) in the liver and spleen. As the child becomes older and RBC life span increases, erythropoiesis is withdrawn…

Bone Marrow Disorders: Haematological Neoplasms

Chapters 65 and 66 deal with various haematological conditions, both neoplastic and non-neoplastic, that may be manifest on imaging of the skeletal system. The recently updated 2016 World Health Organization (WHO) classification of myeloproliferative neoplasms is extremely complex and includes a variety of conditions of differing malignant potential. Only those that have any significant radiological manifestations in the skeletal system will be discussed. Myeloproliferative Neoplasms Polycythaemia…

Reticuloendothelial Disorders: Lymphoma

The lymphomas—a complex group of neoplasms derived from lymphoid cell lines—comprise two broad groups: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Lymphoma is the fifth commonest malignancy in developed countries. The overall incidence of NHL rose steadily from the 1960s, with age-adjusted incidence rates being highest in more developed countries; but it is now beginning to plateau. It is estimated that there will be 75,000 new…

The Breast

Breast cancer is the most common malignancy in the UK with over 55,000 diagnoses annually—almost half of cases (48%) occur in those over the age of 65. It accounts for nearly 11,500 deaths per annum. Imaging is essential for the early detection and accurate diagnosis of breast cancer. Population screening with mammography aims to reduce mortality by detecting the disease at an earlier stage, before it…

Introduction to Oncological Imaging

Cancer is one of the major causes of death in the Western world. The worldwide incidence of cancer is continuing to increase both in developed and developing countries, related to factors such as an ageing population, a shift towards a more Western lifestyle, smoking and environmental factors. In 2012, there were 14.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with…